Ciara Harraher, MD

Clinical Associate Professor, Neurosurgery

Bio

Bio

Ciara D. Harraher, MD, MPH, FRCSC, is a Clinical Associate Professor of Neurosurgery. She received her medical degree from McMaster University in Hamilton, Canada and her Master of Public Health from Harvard University. Dr. Harraher completed her neurosurgery residency at Dalhousie University in Halifax, Canada and fellowships in vascular neurosurgery and Cyberknife radiosurgery at Stanford University School of Medicine.

Dr. Harraher is the Chief of Neurosurgery at Dominican Hospital in Santa Cruz and leads the Stanford Neurosurgery Outreach Clinic. She has a general neurosurgery practice that predominantly treats patients with brain tumors, degenerative spine conditions and carotid stenosis. She is active in her community and regularly speaks at health care events and educational sessions for primary care physicians.

Dr. Harraher is an associate faculty of the Educators for Care (E4C) Program at Stanford Medical School and teaches Principles of Medicine to MD students. Her research interests include surgical outcomes and she is a co-investigator on a clinical trial related to surgical management of stroke. She has co-authored several papers relating to vascular disorders, spine conditions and brain tumor management. She has also spoken internationally on issues related to diversity in neurosurgery.

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Research & Scholarship

Current Research and Scholarly Interests

I am interested in medical education and I am an Associate in the Practice of Medicine and doctoring with CARE ( E4C) Program. I am also interested in surgical outcomes research and I am involved in clinical trials studying brain tumors and stroke. I have also presented internationally on issues related to improving diversity in Neurosurgery.

Abstract

Grade III arteriovenous malformations (AVMs) are diverse because of their variations in size (S), location in eloquent cortex (E), and presence of central venous drainage (V). Because they may have implications for management and outcome, the authors evaluated these variations in the present study.Between 1984 and 2010, 100 patients with Grade III AVMs were treated. The AVMs were categorized by Spetzler-Martin characteristics as follows: Type 1 = S1E1V1, Type 2 = S2E1V0, Type 3 = S2E0V1, and Type 4 = S3E0V0. The occurrence of a new neurological deficit, functional status (based on modified Rankin Scale [mRS] score) at discharge and follow-up, and radiological obliteration were correlated with demographic and morphological characteristics.One hundred patients (49 female and 51 male; age range 5-68 years, mean 35.8 years) were evaluated. The size of AVMs was less than 3 cm in 28 patients, 3-6 cm in 71, and greater than 6 cm in 1; 86 AVMs were located in eloquent cortex and 38 had central drainage. The AVMs were Type 1 in 28 cases, Type 2 in 60, Type 3 in 11, and Type 4 in 1. The authors performed embolization in 77 patients (175 procedures), surgery in 64 patients (74 surgeries), and radiosurgery in 49 patients (44 primary and 5 postoperative). The mortality rate following the management of these AVMs was 1%. Fourteen patients (14%) had new neurological deficits, with 5 (5%) being disabling (mRS score > 2) and 9 (9%) being nondisabling (mRS score ? 2) events. Patients with Type 1 AVMs (small size) had the best outcome, with 1 (3.6%) in 28 having a new neurological deficit, compared with 72 patients with larger AVMs, of whom 13 (18.1%) had a new neurological deficit (p < 0.002). Older age (> 40 years), malformation size > 3 cm, and nonhemorrhagic presentation predicted the occurrence of new deficits (p < 0.002). Sex, eloquent cortex, and venous drainage did not confer any benefit. In 89 cases follow-up was adequate for data to be included in the obliteration analysis. The AVM was obliterated in 78 patients (87.6%), 69 of them (88.5%) demonstrated on angiography and 9 on MRI /MR angiography. There was no difference between obliteration rates between different types of AVMs, size, eloquence, and drainage. Age, sex, and clinical presentation also did not predict obliteration.Multimodality management of Grade III AVMs results in a high rate of obliteration, which was not influenced by size, venous drainage, or eloquent location. However, the development of new neurological deficits did correlate with size, whereas eloquence and venous drainage did not affect the neurological complication rate. The authors propose subclassifying the Grade III AVMs according to their size (< 3 and ? 3 cm) to account for treatment risk.